美国HIV感染者中女性出生性别与慢性肾脏病发生风险之间的关联：一项纵向、多中心队列研究。

Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study.

作者信息

Shelton Brittany A, Sawinski Deirdre, MacLennan Paul A, Lee Wonjun, Wyatt Christina, Nadkarni Girish, Fatima Huma, Mehta Shikha, Crane Heidi M, Porrett Paige, Julian Bruce, Moore Richard D, Christopoulos Katerina, Jacobson Jeffrey M, Muller Elmi, Eron Joseph J, Saag Michael, Peter Inga, Locke Jayme E

机构信息

Department of Public Health, University of Tennessee, Knoxville, TN, United States.

Weill Cornell School of Medicine, United States.

出版信息

EClinicalMedicine. 2022 Sep 17;53:101653. doi: 10.1016/j.eclinm.2022.101653. eCollection 2022 Nov.

DOI:10.1016/j.eclinm.2022.101653

PMID:36159042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9489495/

Abstract

BACKGROUND

Women represent a meaningful proportion of new HIV diagnoses, with Black women comprising 58% of new diagnoses among women. As HIV infection also increases risk of chronic kidney disease (CKD), understanding CKD risk among women with HIV (WWH), particularly Black women, is critical.

METHODS

In this longitudinal cohort study of people with HIV (PWH) enrolled in CFAR Network of Integrated Clinical Systems (CNICS), a multicentre study comprised of eight academic medical centres across the United States from Jan 01, 1996 and Nov 01, 2019, adult PWH were excluded if they had ≤2 serum creatinine measurements, developed CKD prior to enrollment, or identified as intersex or transgendered, leaving a final cohort of 33,998 PWH. The outcome was CKD development, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1·73 m calculated using the CKD-EPI equation, for ≥90 days with no intervening higher values.

FINDINGS

Adjusting for demographic and clinical characteristics, WWH were 61% more likely to develop CKD than men (adjusted hazard ratio [aHR]: 1·61, 95% CI: 1·46-1·78, p<0·001). This difference persisted after further adjustment for risk variants (aHR female sex: 1·92, 95% CI: 1·63-2·26, p<0·001) and substance abuse (aHR female sex: 1·70, 95% CI: 1·54-1·87, p<0·001).

INTERPRETATION

WWH experienced increased risk of CKD. Given disparities in care among patients with end-stage kidney disease, efforts to engage WWH in nephrology care to improve chronic disease management are critical.

FUNDING

US National Institutes of Health.

摘要

背景

新诊断出感染艾滋病毒的人群中，女性占相当比例，其中黑人女性占女性新诊断病例的58%。由于艾滋病毒感染也会增加慢性肾脏病（CKD）的风险，了解感染艾滋病毒的女性（WWH），尤其是黑人女性的CKD风险至关重要。

方法

在这项针对参与综合临床系统CFAR网络（CNICS）的艾滋病毒感染者（PWH）的纵向队列研究中，该多中心研究由1996年1月1日至2019年11月1日期间美国八个学术医疗中心组成，若成年PWH的血清肌酐测量值≤2次、在入组前已患CKD或被认定为双性人或跨性别者，则被排除，最终队列有33998名PWH。结局为CKD的发生，定义为使用CKD-EPI方程计算的估计肾小球滤过率（eGFR）<60 mL/min/1·73 m²，持续≥90天且期间无更高值。

研究结果

在对人口统计学和临床特征进行调整后，WWH发生CKD的可能性比男性高61%（调整后风险比[aHR]：1·61，95%置信区间[CI]：1·46 - 1·78，p<0·001）。在进一步对风险变异因素（女性性别aHR：1·92，95% CI：1·63 - 2·26，p<0·001）和药物滥用情况（女性性别aHR：1·70，95% CI：1·54 - 1·87，p<0·001）进行调整后，这种差异依然存在。